Cluster of Nipah virus infection, Kushtia District, Bangladesh, 2007

Objective

In March 2007, we investigated a cluster of Nipah encephalitis to identify risk factors for Nipah infection in Bangladesh.

Methods

We defined confirmed Nipah cases by the presence of IgM and IgG antibodies against Nipah virus in serum. Case-patients, who resided in the same village during the outbreak period but died before serum could be collected, were classified as probable cases.

Results

We identified three confirmed and five probable Nipah cases. There was a single index case. Five of the secondary cases came in close physical contact to the index case when she was ill. Case-patients were more likely to have physical contact with the index case (71% cases versus 0% controls, p = <0.001). The index case, on her third day of illness, and all the subsequent cases attended the same religious gathering. For three probable cases including the index case, we could not identify any known risk factors for Nipah infection such as physical contact with Nipah case-patients, consumption of raw date palm juice, or contact with sick animals or fruit bats.

Conclusion

Though person-to-person transmission remains an important mode of transmission for Nipah infection, we could not confirm the source of infection for three of the probable Nipah case-patients. Continued surveillance and outbreak investigations will help better understand the transmission of Nipah virus and develop preventive strategies.     

Fatal Outbreak from Consuming Xanthium strumarium Seedlings during Time of Food Scarcity in Northeastern Bangladesh

Background

An outbreak characterized by vomiting and rapid progression to unconsciousness and death was reported in Sylhet Distrct in northeastern Bangladesh following destructive monsoon floods in November 2007.

Methods and Findings

We identified cases presenting to local hospitals and described their clinical signs and symptoms. We interviewed patients and their families to collect illness histories and generate hypotheses about exposures associated with disease. An epidemiological study was conducted in two outbreak villages to investigate risk factors for developing illness. 76 patients were identified from 9 villages; 25% (19/76) died. Common presenting symptoms included vomiting, elevated liver enzymes, and altered mental status. In-depth interviews with 33 cases revealed that 31 (94%) had consumed ghagra shak, an uncultivated plant, in the hours before illness onset. Ghagra shak was consumed as a main meal by villagers due to inaccessibility of other foods following destructive monsoon flooding and rises in global food prices. Persons who ate this plant were 34.2 times more likely (95% CI 10.2 to 115.8, p-value<0.000) than others to develop vomiting and unconsciousness during the outbreak in our multivariate model. Ghagra shak is the local name for Xanthium strumarium, or common cocklebur.

Conclusions

The consumption of Xanthium strumarium seedlings in large quantities, due to inaccessibility of other foods, caused this outbreak. The toxic chemical in the plant, carboxyatratyloside, has been previously described and eating X. strumarium seeds and seedlings has been associated with fatalities in humans and livestock. Unless people are able to meet their nutritional requirements with safe foods, they will continue to be at risk for poor health outcomes beyond undernutrition.     

Febrile Gastroenteritis Due to Salmonella thompson—Report of an Outbreak

Salmonella thompson, a common pathogen of poultry, has received scant attention as a cause of human gastroenteritis. At least 45 persons were infected with S thompson in Sacramento, California, after eating at a chicken restaurant and 38 became symptomatic. Ten required admission to hospital, and all were treated with antibiotics and improved. In 19 cases cultures of stool specimens for S thompson over a 60-day period showed slower but statistically insignificant differences in salmonellal elimination in 7 patients who received antibiotics when compared with 12 who were untreated. We report this outbreak to increase awareness of the virulence and prevalence of gastroenteritis due to S thompson.     

The Duration of Gastrointestinal and Joint Symptoms after a Large Waterborne Outbreak of Gastroenteritis in Finland in 2007 – A Questionnaire-Based 15-Month Follow-Up Study

An extensive drinking water-associated gastroenteritis outbreak took place in the town of Nokia in Southern Finland in 2007. 53% of the exposed came down with gastroenteritis and 7% had arthritis-like symptoms (joint swelling, redness, warmth or pain in movement) according to a population-based questionnaire study at 8 weeks after the incident. Campylobacter and norovirus were the main pathogens.A follow-up questionnaire study was carried out 15 months after the outbreak to evaluate the duration of gastrointestinal and joint symptoms. 323 residents of the original contaminated area were included. The response rate was 53%. Participants were inquired about having gastroenteritis during the outbreak and the duration of symptoms.Of those with gastroenteritis, 43% reported loose stools and abdominal pain or distension after the acute disease. The prevalence of symptoms declined promptly during the first 3 months but at 15 months, 11% reported continuing symptoms. 32% of the respondents with gastroenteritis reported subsequent arthritis-like symptoms. The disappearance of arthritis-like symptoms was more gradual and they levelled off only after 5 months. 19% showed symptoms at 15 months. Prolonged gastrointestinal symptoms correlated to prolonged arthritis-like symptoms.High proportion of respondents continued to have arthritis-like symptoms at 15 months after the epidemic. The gastrointestinal symptoms, instead, had declined to a low level.     

Large outbreak of food poisoning caused by Salmonella typhimurium definitive type 49 in mayonnaise.

An investigation was conducted to determine the vehicle of infection of an outbreak of food poisoning in a large metropolitan building early in 1988. A questionnaire was distributed to 700 people who had eaten in the building during the week of the outbreak, and attack rates for specific food were calculated. Food and stool samples, environmental samples, and eggs and environmental swabs from the egg suppliers were examined microbiologically. Altogether 474 questionnaires were returned, 120 people reporting gastrointestinal illness. The illness was significantly associated with foods containing mayonnaise. Salmonella typhimurium definitive type 49 was isolated from 76 of the 84 stool samples containing salmonella and from five of the eight samples taken from the chicken house of the main egg supplier. Mayonnaise was probably the vehicle of infection, which was caused by S typhimurium definitive type 49.     

The nature of a primary feeding habit in different age-sex classes of yellow baboons (Papio cynocephalus).

Two feeding habits of 30 baboons selected equally from five age-sex classes were studied at Mikumi National Park, Tanzania. The finding, gathering, and preparing of sedge corms and of seeds of tamarind fruit were described in detail. Adults obtained these foods faster than younger animals, although even small juveniles and weaned infants were efficient in gathering and preparing them. While gathering sedges or tamarinds, adult males sat in one place longer than others and obtained more food per sitting. Adults ate more pieces of food per minute than juveniles, but adult rates of eating did not differ by sex. The adult rate of food intake was inconsistent with the assumption of different food requirements for males and females of a species with pronounced sexual dimorphism.     

The fifth outbreak of trichinosis in Korea

Trichinosis is a food-borne zoonotic disease caused by the nematode, Trichinella spp., and had been reported several times in Korea. Recently, there was an additional outbreak, involving 5 patients, the findings from which are reported herein. On 30 November 2010, 8 persons ate sashimi of the meat of a wild boar. Then, 2-3 weeks later, they complained of myalgia and fever. Unfortunately, muscle biopsy was not performed, but ELISA was performed using their sera. Two people among 8 were positive for Trichinella on the 34th day post-infection (PI), and 3 patients who initially revealed negative ELISA were additionally proved to be positive for trichinosis on the 42nd day PI. Hence, the confirmed patients of trichinosis were 5 in total in the present outbreak. They were treated with albendazole and discharged uneventfully. This was the fifth outbreak of trichinosis in Korea.     

Insect and meat eating among infant and adult baboons (Papio cynocephalus) of Mikumi National Park, Tanzania

It has been suggested that baboon predation upon vertebrates may tend to peak in the dry season because insect food is then less available, and that males obtain animal nutrients primarily from vertebrates whereas other troop members obtain them primarily from invertebrates. The development of meat and insect eating by 22 male and 24 female infants studied for 25 months was compared with that of 18 male and 46 female adults studied for 37 months. Systematic sampling allowed quantitative comparisons between meat and insect eating, infants and adults, and males and females. Infants ate no meat, but their insect eating began early and increased steadily during the first year of life. In comparison with insect foods, meat was a minor ingredient of the adult's diet. Insect eating occurred less during dry than during rainy months, but meat eating was spread across the year. Reliable sex differences in insect eating did not occur. The findings were related to theories offered to explain the attractiveness of animal foods to primates and to the suggestion that a sex difference in predatory inclinations of hominid ancestors may have been a preadaptation underlying the eventual emergence of male hunting and female gathering.     

A food‐borne outbreak of gastroenteritis due to genotype G1P[8] rotavirus among adolescents in Japan

Six high school students in Tochigi prefecture, Japan, developed gastroenteritis after eating at a pork cutlet shop. Molecular epidemiologic analyses showed that the causative agent was genotype G1P[8] rotavirus (RV), this being detected in stool samples from both the patients and the asymptomatic food handlers. The detected RV strains were closely related genetically. The only uncooked food that all victims had eaten was raw sliced cabbage. These findings results suggest that uncooked foods contaminated with RV may be sources of infectious gastroenteritis in adolescents.     

Hepatitis A outbreak in Anchorage,Alaska, traced to ice slush beverages.

The Alaska Department of Health and Social Services investigated a community outbreak of hepatitis A in Anchorage. A total of 57 persons who had hepatitis A between June and September 1988 were studied. Patients ranged from 1 to 54 years of age. A market was implicated as the source of the outbreak. An employee who prepared beverage mixtures in a bathroom was a contact of a person who had had hepatitis A 2 months before the outbreak; the employee was reported to have been jaundiced 3 to 4 weeks before the peak of the outbreak. The administration of immune globulin had an efficacy of 100% (95% confidence limits 69, 100%) in preventing hepatitis A among household contacts of primary cases. Similar beverages are sold by convenience markets and many other businesses nationwide. It is important to ensure that safe food-handling practices are followed by such establishments.     

National outbreak of Salmonella serotype saintpaul infections: importance of Texas restaurant investigations in implicating jalapeño peppers

Background

In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak''s source.

Methodology/Principal Findings

We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2–386; Restaurant B: mOR, 13; 95% CI 1.3–infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain.

Conclusions/Significance

Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination.     

Epidemiology of Acute Gastroenteritis Outbreaks Caused by Human Calicivirus (Norovirus and Sapovirus) in Catalonia: A Two Year Prospective Study, 2010-2011

BackgroundThe epidemiology of cases of acute gastroenteritis (AGE) of viral etiology is a relevant public health issue. Due to underreporting, the study of outbreaks is an accepted approach to investigate their epidemiology. The objective of this study was to investigate the epidemiological characteristics of AGE outbreaks due to norovirus (NoV) and sapovirus (SV) in Catalonia.ResultsA total of 101 outbreaks were registered affecting a total of 2756 persons and 12 hospitalizations (hospitalization rate: 0.8x1,000,000 persons-year); 49.5% of outbreaks were foodborne, 45.5% person to person and 5% waterborne. The distribution of outbreaks according to the setting showed a predominance of catering services (39.6%), nursing homes and long term care facilities (26.8%) and schools (11.9%). The median number of cases per outbreak was 17 (range 2–191). The total Incidence rate (IR) was 18.3 per 100,000 persons-years (95%CI: 17.6–19.0). The highest IR was in persons aged ≥65 years (43.6x100,000 (95% CI: 41.0–46.2)) (p<0.001). A total of 1065 samples were analyzed with a positivity rate of 60.8%. 98% of positive samples were NoV (GII 56.3%; GI 4.2%; GII+GI 4.2%; non- typable 33.0%). SV was identified in two person-to-person transmission outbreaks in children.ConclusionsThese results confirm the relevance of viral AGE outbreaks, both foodborne and person-to-person, especially in institutionalized persons. SV should be taken into account when investigating viral AGE outbreaks.     

Molecular-epidemiologic characteristic of hepatitis A outbreak among workers of food stores network

Investigation of hepatitis A (HA) outbreak developed in 2005 among workers of food stores networkwas performed using conventional epidemiologic diagnostics as well as methods of molecular epidemiology. In 14 of 15 ill persons, using polymerase chain reaction, HAV RNA was detected by PCR in serum obtained on 2 - 25 day of illness (mean - 9.3 days). In 10 cases it was possible to determine nucleotide sequence of VP1/VP2 region of HAV genome and perform phylogenetic analysis of obtained isolates. It was determined that all isolates belonged to subgenotype IA, had high degree of homology and grouped in one cluster. These findings demonstrate their descendance from one source of infection, which, with high degree of probability, was the cook who made salads from fresh vegetables. HAV strain, which caused this epidemic outbreak circulates in Saint Petersburg for a long time and was already detected in 2004. Importance of vaccination against HA for persons working in manufacturing and distribution of food and use of molecular epidemiologic methods of surveillance for this infection is underlined.     

Outbreak of Food-poisoning Caused by Salmonella Virchow in Spit-roasted Chicken

Salmonella virchow food-poisoning acquired from eating chicken caused illness in at least 50 people who attended a tennis club function in Liverpool, and in many other people in the Merseyside area. In some cases the illness was severe, with positive blood cultures, and 35 people were admitted to hospital.The source of infection was a retail shop which received deep-frozen chickens already contaminated with S. virchow from a packing-station in Cheshire. These chickens were spit-roasted after inadequate thawing and subsequently handled under unhygienic conditions. The result was a massive build-up of salmonella contamination in the shop and in the chicken portions sold.S. virchow was isolated from over 160 patients and contacts in the Merseyside area during the outbreak and many continued to excrete the organism in the faeces after four months. Antibiotic treatment was not recomended because there was no evidence that it shortened the duration of excretion.A high rate of contamination of chickens from a packing-station by a salmonella type capable of causing serious disease in man is clearly a public health problem which cannot be ignored.The use of rotary spits for roasting chickens requires thorough investigation and appraisal, because as operated at present they evidently constitute a public health hazard.     

Altered Feeding Patterns in Rats Exposed to a Palatable Cafeteria Diet: Increased Snacking and Its Implications for Development of Obesity

Background

Rats prefer energy-rich foods over chow and eat them to excess. The pattern of eating elicited by this diet is unknown. We used the behavioral satiety sequence to classify an eating bout as a meal or snack and compared the eating patterns of rats fed an energy rich cafeteria diet or chow.

Methods

Eight week old male Sprague Dawley rats were exposed to lab chow or an energy-rich cafeteria diet (plus chow) for 16 weeks. After 5, 10 and 15 weeks, home-cage overnight feeding behavior was recorded. Eating followed by grooming then resting or sleeping was classified as a meal; whereas eating not followed by the full sequence was classified as a snack. Numbers of meals and snacks, their duration, and waiting times between feeding bouts were compared between the two conditions.

Results

Cafeteria-fed rats ate more protein, fat and carbohydrate, consistently ingesting double the energy of chow-fed rats, and were significantly heavier by week 4. Cafeteria-fed rats tended to take multiple snacks between meals and ate fewer meals than chow-fed rats. They also ate more snacks at 5 weeks, were less effective at compensating for snacking by reducing meals, and the number of snacks in the majority of the cafeteria-fed rats was positively related to terminal body weights.

Conclusions

Exposure to a palatable diet had long-term effects on feeding patterns. Rats became overweight because they initially ate more frequently and ultimately ate more of foods with higher energy density. The early increased snacking in young cafeteria-fed rats may represent the establishment of eating habits that promote weight gain.     

Bottomless Bowls: Why Visual Cues of Portion Size May Influence Intake**

Objective: Using self‐refilling soup bowls, this study examined whether visual cues related to portion size can influence intake volume without altering either estimated intake or satiation. Research Methods and Procedures: Fifty‐four participants (BMI, 17.3 to 36.0 kg/m²; 18 to 46 years of age) were recruited to participate in a study involving soup. The experiment was a between‐subject design with two visibility levels: 1) an accurate visual cue of a food portion (normal bowl) vs. 2) a biased visual cue (self‐refilling bowl). The soup apparatus was housed in a modified restaurant‐style table in which two of four bowls slowly and imperceptibly refilled as their contents were consumed. Outcomes included intake volume, intake estimation, consumption monitoring, and satiety. Results: Participants who were unknowingly eating from self‐refilling bowls ate more soup [14.7 ± 8.4 vs. 8.5 ± 6.1 oz; F(1,52) = 8.99; p < 0.01] than those eating from normal soup bowls. However, despite consuming 73% more, they did not believe they had consumed more, nor did they perceive themselves as more sated than those eating from normal bowls. This was unaffected by BMI. Discussion: These findings are consistent with the notion that the amount of food on a plate or bowl increases intake because it influences consumption norms and expectations and it lessens one's reliance on self‐monitoring. It seems that people use their eyes to count calories and not their stomachs. The importance of having salient, accurate visual cues can play an important role in the prevention of unintentional overeating.     

Longitudinal patterns of breakfast eating in black and white adolescent girls

Objective: The objective was to describe the pattern of breakfast eating over time (“breakfast history”) and examine its associations with BMI and physical activity. Research Methods and Procedures: This longitudinal investigation of patterns of breakfast eating included 1210 black and 1161 white girls who participated in the 10‐year, longitudinal National Heart, Lung, and Blood Institute Growth and Health Study (NGHS). Three‐day food records were collected during annual visits beginning at ages 9 or 10 up to age 19. Linear regression and path analysis were used to estimate the associations between breakfast history, BMI, and physical activity. Results: Among girls with a high BMI at baseline, those who ate breakfast more often had lower BMI at the end of the study (age 19), compared with those who ate breakfast less often. Path analysis indicated that energy intake and physical activity mediated the association between patterns of breakfast eating over time and BMI in late adolescence. Discussion: The association between regular breakfast consumption over time and moderation of body weight among girls who began the study with relatively high BMI suggests that programs to address overweight in children and adolescents should emphasize the importance of physical activity and eating breakfast consistently.     

Problemen en wensen van mantelzorgers van mensen met dementie: een vergelijking tussen de beginfase en latere fasen in het ziekteproces

This paper investigates whether informal caregivers of persons who have had symptoms of dementia for less than a year, differ from informal caregivers of persons in subsequent stages of dementia. Differences will be investigated in (a) problems experienced in the provision of informal care, (b) the use of ambulatory types of professional support, and (c) the need for additional professional support. Results are based on a survey among 1494 Dutch informal caregivers. Almost all informal caregivers experience problems in caring for a person with dementia, irrespective of the stage of the illness process. Their main problems concern dealing with changes in the behaviour of the person with dementia and dreading the person's admission to a nursing home. Informal caregivers of persons who have had symptoms of dementia for a longer period of time (> 1 year) also experience limitations in their social network. Most persons with dementia receive some kind of professional support. Still, the majority of informal caregivers indicate a need for additional professional support, mainly concerning advice and information. Limiting the available support options for persons with initial symptoms of dementia and their informal caregivers is therefore undesirable. Considering the need for additional support in the initial stage of dementia as well as in subsequent stages, persons with dementia and their informal caregivers should be supported during the entire illness process.